title: Pre-operative imaging with CA125 is a poor predictor for granulosa cell tumors.
abstract: OBJECTIVE
  To determine the radiographic characteristics of ovarian granulosa cell tumors (GCTs) and to evaluate the use of CA125 levels >35 in combination with imaging as an algorithm for preoperative diagnosis.
  
  
  METHODS
  A retrospective analysis of women from two academic medical centers who were diagnosed with ovarian GCT between January 1998 and August 2012 was conducted. Clinical data included tumor appearance on pre-operative imaging and CA125 levels. Ovarian cysts were defined as complex if imaging exhibited multicystic areas, hemorrhagic, solid, or cystic and solid components. A CA125 level >35 was abnormal.
  
  
  RESULTS
  One hundred and fifteen women were diagnosed with GCTs, of whom 63 underwent pre-operative imaging. Median age at surgery was 46 years (12-87). Forty women had preoperative ultrasounds, 43 had CT scans and 20 underwent both modalities. GCTs were almost exclusively classified as complex cysts in 62 (98%) cases. The most common morphology was solid and cystic (n=44 (70%)). Forty-four (70%) patients had tumors >10 cm. Forty-two patients had a pre-operative CA125 performed. Eighteen (43%) patients had complex masses and CA125 >35. Twenty-three (55%) had CA125 <35 with a complex mass, and one (2%) had a unilocular cyst with a CA125 >35.
  
  
  CONCLUSIONS
  In this study, there was a near equal distribution of patients with complex masses and CA125 levels > or <35. If established strategies to predict malignancy are applied to GCTs, we will frequently fail to make the diagnosis pre-operatively. Additional research is necessary to generate an appropriate algorithm to guide pre-operative referral to a gynecologic oncologist.
authors.affiliation: University of North Carolina at Chapel Hill, Division of Gynecologic Oncology, USA. Electronic address: jstine@unch.unc.edu.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Stine
authors.forename: Anuj
authors.initials: A
authors.lastname: Suri
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.forename: Michael
authors.initials: M
authors.lastname: Chiu
authors.forename: Britt K
authors.initials: BK
authors.lastname: Erickson
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
authors.forename: John T
authors.initials: JT
authors.lastname: Soper
authors.forename: Linda
authors.initials: L
authors.lastname: Van Le
authors.forename: Michael G
authors.initials: MG
authors.lastname: Conner
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018394:CA-125 Antigen / Q000097:blood*; D002648:Child; D005260:Female; D006106:Granulosa Cell Tumor / Q000097:blood / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D010048:Ovarian Cysts / Q000097:blood / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D018394:CA-125 Antigen
keywords: Granulosa cell tumor; Imaging; Ultrasound